Provider Demographics
NPI:1285471300
Name:SMALL, CARLA MALINDA (MHC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MALINDA
Last Name:SMALL
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHC
Mailing Address - Street 1:2205 LORETTA ROAD
Mailing Address - Street 2:APT F1
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:516-591-7907
Mailing Address - Fax:
Practice Address - Street 1:2205 LORETTA ROAD
Practice Address - Street 2:APT F1
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:516-591-7907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health